Provider Demographics
NPI:1407501414
Name:FRIZZELL, RYLIE ASHLYN (COTA/L)
Entity Type:Individual
Prefix:
First Name:RYLIE
Middle Name:ASHLYN
Last Name:FRIZZELL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2568 LISA DR APT 4
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-2381
Mailing Address - Country:US
Mailing Address - Phone:573-625-9430
Mailing Address - Fax:
Practice Address - Street 1:300 FLOYD DR
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-3960
Practice Address - Country:US
Practice Address - Phone:573-472-0397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021041800224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant